GPAtlas🧭 When to suspect
Suspect nephrotic syndrome in any child presenting with new, fairly rapid-onset oedema – classically periorbital puffiness that is worst on waking and is often mistaken for an allergy – together with peripheral (ankle/foot), scrotal/labial, or abdominal (ascites) swelling. It most often presents between 1 and 10 years of age, with a peak in the preschool years (around 2–5) and a slight male predominance, and frequently follows a minor trigger such as a coryzal illness or sore throat.
The diagnosis is a triad: heavy proteinuria, hypoalbuminaemia, and oedema. Around 90% of childhood cases are minimal change disease (MCD) and are steroid-responsive with an excellent long-term kidney outlook, so the diagnosis is far more often good news than bad. Incidence is roughly 2 per 100,000 children per year and is higher in children of South Asian origin.
The two jobs in primary care are simple but vital: put a dipstick in the urine of every newly swollen child, and arrange same-day paediatric assessment for every first presentation – both to confirm the diagnosis and to catch the dangerous early complications of infection, thrombosis and hypovolaemia.
| Diagnostic feature | Threshold / what to look for |
|---|---|
| Heavy proteinuria | Urine dipstick 3+ or 4+ protein; urine protein:creatinine ratio (uPCR) > 200 mg/mmol on a first-morning sample. |
| Hypoalbuminaemia | Low serum albumin (typically < 25–30 g/L). |
| Oedema | Periorbital (often first and worst in the morning), pitting peripheral oedema, scrotal/labial swelling, ± ascites. |
| Atypical features (point away from simple MCD) | Macroscopic haematuria, sustained hypertension, impaired kidney function, age < 1 or > 12 years, rash/joint pain, or faltering growth – flag for early specialist input. |
Source: UK Kidney Association / BAPN · KDIGO 2025
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